Gestational diabetes is associated with the risk of offspring's congenital anomalies: a register-based cohort study

Impact of maternal overweight/obesity and high fasting plasma glucose on adverse perinatal outcomes in early gestational diabetes mellitus

AIM

To elucidate risk factors associated with adverse perinatal outcomes in early-gestational diabetes mellitus (GDM).

MATERIALS AND METHODS

A dataset of 385 early-GDM cases from a prospective cohort was analyzed. Early-GDM was diagnosed if one or more of the following criteria were met: fasting plasma glucose (PG) levels of 92-125 mg/dL, 1-h PG levels ≥180 mg/dL, and 2-h PG levels ≥153 mg/dL during a 75-g oral glucose tolerance test before 20 weeks of gestation. Multivariate analysis was used to examine associations between candidate risk factors and a composite outcome of maternal and neonatal adverse events.

RESULTS

Pre-pregnancy overweight/obesity (pre-pregnancy body mass index [BMI] ≥25.0 kg/m2) was significantly associated with a higher risk of the composite outcome compared with normal weight (pre-pregnancy BMI of 18.5-24.9 kg/m2), an adjusted risk ratio (aRR) of 1.44 (95% confidence interval [CI]: 1.08-1.93), and an adjusted risk difference (aRD) of 13.6% (95% CI: 2.6-24.6%). Compared with fasting PG levels below 92 mg/dL, levels between 95 and 125 mg/dL were associated with a significantly higher risk of the composite outcome, with an aRR and aRD of 1.42 (95% CI: 1.01-1.99) and 12.9% (95% CI: 0.3-25.5%), respectively.

CONCLUSIONS

Early-GDM, combined with pre-pregnancy overweight/obesity and/or fasting PG levels of 95-125 mg/dL, is associated with a higher risk of adverse perinatal outcomes and should be prioritized for intervention.

Maternal hyperglycemia affects cell proliferation signalling and stromal organization in the prostate of neonatal and juvenile rat offspring

Gestational diabetes mellitus is a common medical complication during pregnancy. It creates a hyperglycemic environment and impacts offspring development, increasing the risk of long-term complications, including obesity, impaired glucose metabolism and cardiovascular disease. The impact of gestational diabetes on the prostates of adult offspring has already been described; however, it is not known whether these effects are due only to the maternal condition or whether the offspring develop them throughout life. This investigation evaluated the prostates of neonatal and juvenile offspring of hyperglycemic rats due to diabetes. Diabetes was induced with streptozotocin (50 mg/kg, ip) in pregnant Wistar rats and the prostates of 7- or 30-day-old pups from healthy (PC7, PC30) or diabetic (PD7, PD30) mothers were evaluated. We found reduced body weight in pups of PD7 and PD30 and prostate weight in PD30. Prostate branching was not affected, but a reduction in apoptotic levels was associated with impaired acinar bud canalization in neonates. Additionally, PD7 presented reduced ERK1/2 phosphorylation, cell proliferation and collagen, but fibroblasts were increased. In PD30, there was a reduction in the area of the secretory epithelium and stroma, but the luminal area was increased. Moreover, fibroblasts, smooth muscle cells, collagen and metalloproteinase 2 were decreased in these juvenile pups. These data indicate that maternal hyperglycemia inactivates an important cell proliferation signaling pathway in the prostate in the first postnatal days (which is restored in the juvenile period), but it was not sufficient to avoid epithelial and stromal atrophy. This effect on postnatal gland development may impact the reproductive capacity of the prostate in adult life.

Changes in Oxidative Stress Markers in Pregnant Women of Advanced Maternal Age with Gestational Diabetes and Their Predictive Value for Neurodevelopmental Impact

Objective

To explore the relationship between changes in oxidative stress markers in pregnant women of advanced maternal age with gestational diabetes mellitus (GDM) and adverse pregnancy outcomes and neonatal neurodevelopment, as well as their predictive value.

Methods

Two hundred pregnant women of advanced maternal age were selected and divided into Group A (normal blood sugar) and Group B (GDM) based on the 75 g (Oral Glucose Tolerance Test) OGTT results. Oxidative stress markers were measured, and pregnancy outcomes and neonatal Neonatal Behavioral Assessment Scale (NABA) scores were recorded.

Results

Malondialdehyde (MDA) levels in Group B were higher than those in Group A, while Glutathione (GSH) and Superoxide Dismutase (SOD) levels were lower. Group B had higher rates of adverse pregnancy outcomes and neurological abnormalities than Group A. The Area Under the Curve (AUC) values for serum MDA, GSH, and SOD levels combined prediction were higher than those for individual predictions (P<0.05).

Conclusion

Oxidative stress markers in pregnant women of advanced maternal age with GDM are associated with adverse pregnancy outcomes and neonatal abnormalities, and combined prediction has good predictive efficiency (AUC>0.7).

Maternal, Fetal, and Labour Outcomes of Dupilumab Use for Atopic Dermatitis During Pregnancy: A Systematic Review

Atopic dermatitis is a chronic complex inflammatory disease that significantly impacts maternal well-being and quality of life during pregnancy, warranting effective therapeutic interventions that prioritize maternal health and fetal safety. Dupilumab is approved for moderate-to-severe atopic dermatitis, but limited data exist regarding its safety during pregnancy. We conducted a systematic review to review and analyze maternal, fetal, and labour outcomes in patients receiving dupilumab for atopic dermatitis during pregnancy. Comprehensive searches were conducted using databases including OVID, Scopus, and Web of Science, covering studies published until May 2024. Our search yielded 285 studies, of which 13 met the eligibility criteria. These studies included 68 patients with 69 pregnancies, revealing 58 live births and 11 spontaneous abortions. Dupilumab therapy was administered continuously throughout pregnancy in 22.2% of cases, while 77.8% received intermittent treatment. Maternal atopic dermatitis outcomes showed significant improvement in disease severity. Most pregnancies (86.3%) progressed without complications. Labour-associated outcomes varied, with 82.4% of women undergoing vaginal deliveries. The majority of births occurred at full term (82.5%), with a mean gestational age of 38.4 weeks. Fetal outcomes demonstrated a normal birth weight in 92.3% of cases, with no reported congenital defects. Our review suggests that dupilumab use during pregnancy is associated with improvement of atopic dermatitis and low or minimal risk of major adverse outcomes in treated patients or their newborns. Prospective studies with long-term follow-up are warranted to confirm the safety of dupilumab in this population.

Prevalence, characteristics and risk factors of birth defects in central China livebirths, 2015-2022

Objective

This study analyzed the prevalence, epidemiological characteristics and risk factors of birth defects among livebirths in central China, aiming to provide evidences for the prevention of birth defects and government Decision-makings.

Methods

Birth data from China's Hubei Province between 2015 and 2022 were collected, including basic information of the livebirths, the mothers and the fathers, as well as information about delivery and each prenatal examination. The livebirths prevalence of birth defects was calculated and the trends were mapped. The basic characteristics of birth defects were evaluated by the difference analysis between case and health groups. Univariate and multivariate Poisson regression was performed to examine the independent risk factors for birth defects.

Results

Among 43,568 livebirths, 166 livebirths were born with birth defects, resulted in a total prevalence rate of 3.81 per 1,000 livebirths, showing a remarkable uptrend from 0.41per 1,000 livebirths in 2015 to 9.23 per 1,000 livebirths in 2022. The peak of the prevalence was in January and February. Congenital malformation of the musculoskeletal system was the main type of birth defect in central China livebirths, followed by cleft lip and cleft palate. Overall, newborns with birth defect had significantly earlier delivery gestational age, poorer health and higher proportion of infants with low birth weight than healthy births. The gender of livebirths, excess weight at delivery (≥80 kg) of mothers, more than 2 times of gravidity or parity of mothers, and advanced paternal age (≥40 years) were independent risk factors for birth defects (or specific birth defects).

Conclusion

The livebirths prevalence of birth defects shows increasing trend in central China, which deserves the attention of the government and would-be parents. Elevated paternal age, excess maternal weight, gravidity and parity should be considered when planning their families.

Birth defects and epidemiological factors in Tunisia

AIM

To identify the birth defects listed in the embryo-fetopathology department of the maternity and neonatology center of Tunis (Tunisia), and to study the epidemiological factors.

METHODS

We carried out a retrospective study on 2489 malformed cases including fetuses, stillborns and deceased newborns among 5750 ones autopsied in the embryo-fetopathology department of the maternity and neonatology center of Tunis.

RESULTS

The sex ratio of autopsied cases was 1.06. 41% of them weighed less than 500 grams. The gestational age was between 22-28 weeks of amenorrhea in 41.3% of cases. Among the maternal characteristics, we noted an average maternal age of 30.1 years old (with extremes ranging from 16 to 51 years old), and a predominance of O blood group. Parental consanguinity and history of reproductive failure were found respectively in 37.4% and 32.5% of cases. Antenatal diagnosis was established in 62% of cases. It was positive in 59.5% of cases (all types of malformations combined). Among the 2489 malformed cases, 4568 birth defects were identified. Neurological anomalies were the most common (26.01%) followed by nephro-urological anomalies (13.16%) and cardiovascular anomalies (11.47%). During the study period, 164 cases of polymalformative syndromes were counted and 217 cases of chromosomal aberrations were classified.

CONCLUSION

This study allowed us to assess the frequency of birth defects, categorize them based on their type and determine the different epidemiological factors during a long period of nine years, even though our nation does not have a national register of birth defects. In Tunisia, it is important to carry out a national multicenter study in order to set a national register representing the real statistics of these anomalies.

The mediating effect of e-health literacy on social support and behavioral decision-making on glycemic management in pregnant women with gestational diabetes: a cross-sectional study

Background

Social support and e-health literacy are closely related to individual health behaviors, while behavior is premised on decision-making. Few studies have identified the relationships among social support, e-health literacy, and behavioral decision-making, and the nature of these relationships among pregnant women with gestational diabetes remains unclear. Therefore, this study aimed to investigate relationships among social support, e-health literacy, and glycemic management behavioral decisions in pregnant women with gestational diabetes.

Methods

Using continuous sampling, an online cross-sectional survey was conducted among pregnant women with gestational diabetes who met the inclusion and exclusion criteria at four Class 3 hospitals in Fujian Province from October to December 2023. A structured questionnaire was used to collect data on general characteristics, socioeconomic status, social support, e-health literacy, and behavioral decision-making regarding glycemic management. Descriptive statistical analyses, correlation analyses, and mediation effects were used to assess associations.

Results

A total of 219 pregnant women with gestational diabetes participated, and 217 valid results were obtained. The level of glycemic management behavior decision-making in women with gestational diabetes was positively correlated with e-health literacy (r = 0.741, p < 0.01) and with perceived social support (r = 0.755, p < 0.01). E-health literacy was positively correlated with perceived social support (r = 0.694, p < 0.01). The indirect effect of perceived social support on glycemic management behavior decisions through e-health literacy (a*b) was 0.153, accounting for 38% of the total effect.

Conclusion

Social support and e-health literacy in pregnant women with gestational diabetes are related to behavioral decision-making in glycemic management. The results of this study provide a reference for developing targeted measures to improve glycemic management behaviors in pregnant women with gestational diabetes, which is crucial for achieving sustainable glycemic management.

The landscape of fetus metabolism in maternal hyperglycemia

Maternal hyperglycemia contributes to abnormal fetal development; yet, how it affects fetal metabolism is poorly understood. Perez-Ramirez and colleagues recently provided a comprehensive metabolic atlas of fetal organs isolated from normal and diabetic pregnant mice, identifying novel metabolites and alterations in tissue glucose utilization throughout mid-to-late gestation by maternal hyperglycemia.